Oncologists’ preferences for first-line treatment of ALK-positive metastatic NSCLC in the United States: a discrete choice experiment

Tradeoffs between efficacy, safety, and administration may influence decision-making for first-line (1L) treatments for ALK+ mNSCLC. This study explored heterogeneity in provider preferences. A survey of US oncologists treating ≥1 ALK+ mNSCLC patient was conducted June–August 2024. Participants answered 12 questions comparing 1 L profiles characterized by eight treatment attributes for patients without brain metastases. Attributes included 3-year PFS, intracranial duration of response (iDOR), 16-month risk of edema, myalgia, or cognitive effects, grade ≥3 interstitial lung disease/pneumonitis, 2 L+ treatment options, and administration. Relative attribute importance (RAI) (0–100%) was calculated for aggregate efficacy and safety attributes. Latent class analysis (LCA) explored preference heterogeneity and differences in respondent characteristics. In total, 201 oncologists completed the discrete choice experiment. Oncologists emphasized the efficacy over safety (RAI = 47.0% vs 39.0%). LCA identified two classes, placing similar importance on efficacy (RAI = 44.5% vs 48.2%) and safety (RAI = 39% vs 41.2%), but preferring different levels in five attributes. Class 1 oncologists (61%) preferred 3-year PFS of 64% over 43–46%, while Class 2 oncologists (39%) did not differentiate. Conversely, Class 2 focused on iDOR. We identified two oncologist groups with distinct preferences for treatment attributes. Given various 1 L ALK+ mNSCLC treatments, clinical decision-making balances multiple objectives. We surveyed 201 US-based oncologists to understand what characteristics of different treatment options for ALK+ metastatic non-small cell lung cancer impact clinical decisions. We asked about the role each treatment’s efficacy, side effects, and administration play in treatment choices, using a Discrete Choice Experiment approach. We found that oncologists valued efficacy over a treatment’s side effect profile and that there were two distinct groups of oncologists with respect to treatment preferences. While both groups placed similar value on efficacy outcomes, one group’s clinical decisions were largely driven by a treatment’s ability to slow disease progression, while the other group’s clinical decision depended on a treatment’s ability to protect the patient from developing brain metastases. This suggests that the treatment decisions for patients with ALK+ metastatic non-small cell lung cancer are complex and that physicians balance multiple-treatment objectives in their choice of therapy.